Patient-centred access to health care: conceptualising access at the interface of health systems and populations

International Journal for Equity in Health

Grant Russell¹  Mark F Harris³  Jean-Frederic Levesque² 

[1] Monash University, Wellington Road, Clayton, VIC 3800, Australia;Institut national de santé publique du Québec, 190 Crémazie Est, Montréal, QC H2P1E2, Canada;University of New South Wales, Sydney, NSW 2052, Australia

关键词: Availability;    Utilisation of health services;    Accessibility;    Access to healthcare;   

Others  :  825077
DOI  :  10.1186/1475-9276-12-18

 received in 2012-11-05, accepted in 2013-03-07,  发布年份 2013

【 摘 要 】

Background

Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.

Methods

A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.

Results

Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.

Conclusions

This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.

【 授权许可】

   
2013 Levesque et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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